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Work Permit Decision

This is a straight forward checklist that needs to be followed when applying for a work permit. It also documents important information for the job you're applying for.
TX Whiskey
04/25/2024

Work Permit Decision

This is a straight forward checklist that needs to be followed when applying for a work permit. It also documents important information for the job you're applying for.

    Does this Job or Task Include any of the following?

    if the answer is "oneOf [Hot Work,Working at Heights,Excavation,Critical Lift,Live Electrical,High Voltage ,Line Break,Confined Space Entry]"

    Safe Work Permit

    Section A- Project Information

    Contractor Name & Contact Number

    Job Location

    US Whiskey Project Manager Name and Contact Number

    Date

    Time

    Section B- Nature of Work/Method Statement

    What work are you doing?

    How is this going to be performed?

    Where will it happen?

    Section C- Work Activities

    Identify the work activities you will perform

    if the answer is "oneOf [Other]"

    What Other?

    if the answer is "oneOf [Confined Space entry,Critical Lift,Excavation,Working at Heights,Hot Work,Line Breaking,Safety System OOS,Working on Energized Electrical Equipment,High Voltage (>1000V),High Pressure Blasting]"

    Your activity requires an additional permit or risk assessment.

    Section D- Actual and Potential Hazards

    Identify the actual and potential hazards

    if the answer is "oneOf [Other]"

    What other?

    if the answer is "oneOf [Other]"

    What other?

    Section E- Hazard Mitigation

    Identify the PPE you will use to mitigate your risks.

    if the answer is "oneOf [Gloves (Specify Below)]"

    What type of gloves will you use?

    if the answer is "oneOf [Other]"

    What other?

    Identify the Hazard Control Measures you will use to mitigate risks.

    if the answer is "oneOf [Other]"

    What other?

    Section F- Risk Assessment & Controls

    Identify the hazards, mitigation, and controls from sections D and E and perform a Job Safety Analysis

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Section G- Acknowlegment

    PERMIT I AM CERTIFYING THIS JOB & PERMIT WAS REVIEWED AND ISSUED BY:

    Click here to sign

    TIME ISSUED

    TIME EXPIRES

    PERMIT RECEIVER

    Click here to sign

    TIME ISSUED

    TIME EXPIRES

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    PRE JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    PRE JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    MID JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    MID JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    POST JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    POST JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    WAS THE JOB COMPLETED

    Add or drag pictures
    if the answer is "oneOf [None]"

    Select what applies to your job or task

    if the answer is "oneOf [The job or task includes recognized hazards. There is no SOP or JSA for the job or task,The job or task includes recognized hazards. There is an SOP or JSA in place. The task is performed less that every 6 months.]"

    Safe Work Permit

    Section A- Project Information

    Contractor Name & Contact Number

    Job Location

    US Whiskey Project Manager Name and Contact Number

    Date

    Time

    Section B- Nature of Work/Method Statement

    What work are you doing?

    How is this going to be performed?

    Where will it happen?

    Section C- Work Activities

    Identify the work activities you will perform

    if the answer is "oneOf [Other]"

    What Other?

    if the answer is "oneOf [Confined Space entry,Critical Lift,Excavation,Working at Heights,Hot Work,Line Breaking,Safety System OOS,Working on Energized Electrical Equipment,High Voltage (>1000V),High Pressure Blasting]"

    Your activity requires an additional permit or risk assessment.

    Section D- Actual and Potential Hazards

    Identify the actual and potential hazards

    if the answer is "oneOf [Other]"

    What other?

    if the answer is "oneOf [Other]"

    What other?

    Section E- Hazard Mitigation

    Identify the PPE you will use to mitigate your risks.

    if the answer is "oneOf [Gloves (Specify Below)]"

    What type of gloves will you use?

    if the answer is "oneOf [Other]"

    What other?

    Identify the Hazard Control Measures you will use to mitigate risks.

    if the answer is "oneOf [Other]"

    What other?

    Section F- Risk Assessment & Controls

    Identify the hazards, mitigation, and controls from sections D and E and perform a Job Safety Analysis

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Hazard / Risk / Condition

    Controls to Establish

    (Consider the hierarchy controls: Elimination, Substitution, Engineering, Administrative, PPE)

    Company / Person Responsible

    Section G- Acknowlegment

    PERMIT I AM CERTIFYING THIS JOB & PERMIT WAS REVIEWED AND ISSUED BY:

    Click here to sign

    TIME ISSUED

    TIME EXPIRES

    PERMIT RECEIVER

    Click here to sign

    TIME ISSUED

    TIME EXPIRES

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    SIGNITURE OF OTHER PERSONNEL WORKING ON THIS JOB

    Click here to sign

    PRE JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    PRE JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    MID JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    MID JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    POST JOB FIELD REVIEW- PERMIT APPROVER AND TIME

    POST JOB FIELD REVIEW- PERMIT RECEIVER AND TIME

    WAS THE JOB COMPLETED

    Add or drag pictures
    if the answer is "oneOf [The job or task does not include recognized hazards,The job or task includes recognized hazards. There is an SOP or JSA in place. The task is performed more than every 6 months.]"

    No permit is required

Source: TX Whiskey (Community Member)

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